Tuesday, September 20, 2011

flying monkeys

It's been a rough 24 hours emotionally, but I feel like I'm pulling it out of it now. This is good. I wasn't sure how much I wanted to share here, but then I realized that this is my blog, and hey, my blog, my rules.

For those of you just joining us, hi, I'm Lesley. I have lost over 200 lbs. How ya like them apples? I have three different endocrine disorders which led to my being morbidly obese in the first place. Well, actually, I was considered Super Morbidly Obese, Class II, but you know I've always been an over-achiever. So those three endo disorders I mentioned? Well, they all contribute to something usually described as marked central obesity, which basically means that a lot of my weight took up residence in my abdomen. So now that I've lost so much weight already, as you can imagine, there's a serious amount of excess tissue** that needs to be dealt with. I can't exercise it away. I can't diet it away. There is no way for me to do anything more for this. I have to have surgery for it.

Oh and on a fun little side note, because I really need to lighten the mood in here, the excess skin monster that I'm currently rockin' is called a panniculus, but most people call it a panni for short. Not me, though. I call mine Zamfir. Why? Well, my brain works in weird ways (remember, I named my stomach pouch Seymour), but remember the guy with the infomercials of his panflute music? That was Zamfir! No one wanted Zamfir or his panflute, and I certainly don't want this pan-whatever-the-hell-you-wanna-call-it now. Be gone, Zamfir!

So I went for some consultations, chose a plastic surgeon who does a lot of post-massive-weight-loss work and who also operates at the same surgery clinic where I had my original surgery, and started to gather documentation. Primary doctor, dermatologist, gynecologist, knee doctor, weight-loss surgeon, and endocrinologist all wrote letters, although the most important one in the insurance company's eyes is the one from the dermatologist. Fortunately, I had specifically asked my primary to send me to a derma who does excellent documentation, so I felt good about that. I knew Dr. L was writing copious notes about the rashes, irritation, and infections that I had and still have in my excess skin. (Yes, all of that is painful. I hide it well.) And she did a good job of effectively communicating this in her letter to the insurance company. All of this information, along with some naked photos of yours truly, has gone to the insurance company. And now they've come back and said that they want actual photocopies of the dermatologist's chart notes. And when the surgeon's insurance person called me she was a bit of a Debbie Downer about my chances for approval (despite the fact that the plastic surgeon himself was pretty confident about it when I saw him), based on my current BMI. What about the BMI? Well, I'll explain.

You see, the insurance company does have criteria that they like to follow for approving the panniculectomy, otherwise they consider it to be a cosmetic procedure. I meet all of their requirements except for one, and that is that they would like for a patient's BMI to be 30 or lower, and I am not there. And I can't get there because there's really nothing left that I can lose without it being cut off of me. 30 would be a good number for someone whose pre-weight-loss-surgery BMI was around 40. Mine was 78, and these days is 35. No small accomplishment, that. In fact, it's much better than what the statistics predicted for me, and what several physicians predicted as well.

So even though I know that worrying won't do me any good, getting this phone call from my surgeon's insurance person last night made me very sad, very worried, and a bunch of other unpleasant feelings. And then I just got indignant about the whole thing. I mean, okay, indulge me for a moment, would you? I can't think of anyone else who deserves this more than I do. I have worked my ass off. I haven't let things stop me or sat around and complained and felt sorry for myself. When I realized the excess skin was getting to be an issue, I made phone calls and called around to find support garments so that I could still exercise. I exercise more than anyone I know. Hell, I even became a group fitness instructor! And I am religious about my eating habits. I track everything that goes into my mouth, and I keep my carbs very low. And I keep up with my bloodwork, vitamins, doctor's appointments, etc. I've done everything right, and I've been steadfast in my determination.

So why can't this be easy? Why can't my case be approved quickly? Why do I have to present documentation from every doctor I've ever met? How can anyone look at my case and my documentation and my photos (ugh!) and not think this is medically necessary? And, God help me, why do I now have to give them MORE documentation? It's enough already!

I feel like that part in the "Wizard of Oz" when they get to the Wizard and he's all "oh no, bitches, I know you've already worked your asses off to get here and suffered many hardships, but you have to bring me the witch's broomstick first!" and so Dorothy & friends embark on this perilous mission, and it's pretty obvious that the Wizard expects them to give up and/or die so that he won't have to help them.  I can't help but think that they'll continue asking me for this, that, and the other thing, hoping that I'll give up and either forget about surgery (no way) or pay for it myself (ugh).

Well, after spending the last 24 hours stewing in my melancholy juices I do feel better now. And I even feel empowered to go kick some ass and see this thing through. Some of the guys I worked with used to call me The Pitbull (long before a Cuban rapper stole my nickname, mind you) and, well, it's time for them to meet The Pitbull. I've made my to-do list, and I'm getting it done. I called the derma's office twice today and of course no one has called me back, so first thing tomorrow morning, my ass will be in their office. And I'm not leaving until I have the photocopies I need.

As for the BMI issue, well, if they deny me based on that, I'm ready to fight. I've already spoken with a friend who works in insurance approvals (she works in mental health, but still, she knows her way around the system) and she explained what my options are for appealing a denial. I am so doing this. More documentation? Yeah, here ya go! An in-person meeting? Sure why not, I'll drive up to Albany and whip out Zamfir for them. And I'm bringing my girl gang with me. That would be way scarier than flying monkeys, you know.

So the Wizard can continue to have his smoke and mirror machine, but I'm showing up with that broomstick. Except I will be a bad-ass Dorothy and storm into their offices all "Hey, here's your fucking broomstick, fuckers! You know where to stick it!"

p.s. I apologize for the overuse of italics, hyphens, sharing, and profanity in today's blog. That's all.

**I know some of you are horrified by the idea of excess tissue, and many people have told me that they don't want to lose weight, whether by surgery or other means, because they don't want the excess skin. I can't even convey to you how stupid I think that is. Even if insurance denied me and I was not in a position to pay for this myself***, I'd still rather deal with sagging skin and vastly improved health, rather than deal with diabetes, constant pain, feeling depressed about my weight, not wanting to go anywhere, having no energy, and premature death. Honestly, as bad as it is, it's not as bad as I was expecting. I would still opt for surgery plus diet + exercise a million times over. I cannot overstate that.

***In the unlikely scenario that I can't get coverage, I will finance it myself. I've already looked into my options. I'm sad because I'd rather use the money for Lasik, but I guess I'll have to wear glasses for a few more years in that (unlikely) scenario.

5 comments:

Theresa said...

You go girl! Sending insurance approval vibes your way...all the way across the country. Good Luck! Damn the Man!!!!

sairy said...

Sending all the love, mojo, and good vibes you sent my way for my certification back your way - will light a billion candles for this insurance approval for you sweets. Thank you for sharing your journey - it is incredibly inspiring!

Jenn from WA said...

Wow, that's one brave, or stupid, insurance company...to mess with The Lesley. They know not what they do.

And if they did...you'd be approved ASAP.

Lesley said...

Thanks, ladies! I appreciate it.

knittinpreacher said...

Just checking in -- stupid insurance company! Remember, they hope to make things hard so that you will give up and they don;t have to pay for it. DO NOT GIVE UP.

Would you like a note from a spiritual advisor telling them that denying you is stupid? :)